Rapid implementation of remote digital primary care in Stockholm and implications for further system-wide implementation: practitioner's and manager's experience of the Always Open mobile application

• Published in: Scandinavian journal of primary health care Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 15
• Main Authors: Solberg Carlsson, Karin, Øvretveit, John, Ohrling, Mikael
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.09.2023; Taylor & Francis LLC; Taylor & Francis Group
• Subjects: Content analysis; COVID-19; Covid-19 pandemic; Decentralization; Digital technology; Focus groups; Health care; Implementation; Interviews; management; Medical technology; NASSS framework; Pandemics; Primary care; Telemedicine; Treatment preferences; telemedicine; primary care; Covid-19 pandemic; management; NASSS framework
• ISSN: 0281-3432; 1502-7724; 1502-7724
• DOI: 10.1080/02813432.2023.2229387

Objective: To contribute actionable knowledge how to increase appropriate use of digital technologies in primary care by understanding clinical managers experiences with a digital connection system, Always Open, during the COVID-19 pandemic. Design and subjects: The overall design was a qualitative study with directed content analysis method. Data were collected from documents and focus group (n = 12) interviews with clinical managers (n = 99) of primary care. The seven domains of the Non-adoption, Abandonment, and challenges to the Scale-up, Spread and Sustainability (NASSS) framework was used to understand the implementation process, as described by the clinical managers. Results: Focus group participants reported that their units made their own local decisions to make more use of the technology provided by the health system. Most participants considered that the technology was ready to use, despite some limitations, that included individual clinician's and patient preferences, and how ready their unit was for making changes to practice and organization. Some raised concerns about how standardizing some aspects possibly conflicted with the decentralized management model of the organization. The overall experience was reported to be positive, with an intention to sustain the achievements. Conclusion: Focus group interviews found that clinical unit managers reported that they and their staff were positive about the digital technology system for remote care. For the future, they wanted changes to be made at different levels of the health system to better combine digital and physical care. Possibilities to use digital technology to integrate primary and hospital health care were identified. Rapid adoption of Always Open as a digital connection mHealth system for remote digital care was observed during the pandemic without a structured implementation program. Many factors could explain the rapid adoption and the intention to sustain the use of Always Open such as professional ethics, financial reimbursement, patient needs and support. Standardization needs to be balanced with flexibility to ensure that staff can decide what is appropriate for patients. The general experience was positive and a continual high use of Always Open was reported in units that adopted the system. The decentralized management model may have contributed to the capacity to provide flexible services suited to local needs.